Cilostazol monotherapy significantly reduced the risk of any stroke by 33% (RR 0.67) and lowered bleeding rates compared to aspirin, but increased the incidence of headache and dizziness.
Meta-Analysis (n=5,617)
Does cilostazol monotherapy reduce the occurrence of any stroke compared to aspirin monotherapy in patients requiring secondary stroke prevention?
In Asian populations, cilostazol monotherapy is superior to aspirin for secondary stroke prevention, significantly reducing both recurrent stroke and bleeding risks, though it increases the incidence of headache, dizziness, and tachycardia.
Relative Risk: 0.67 (95% CI 0.55–0.82)
p-value: p=<0.0001
BACKGROUND: Cilostazol is often used in Asia-Pacific countries for stroke prevention. The current systematic review and meta-analysis aimed to evaluate the effectiveness, safety, and adverse outcomes of cilostazol monotherapy compared to aspirin monotherapy for secondary stroke prevention. METHODS: The researchers conducted a comprehensive research in multiple databases (PubMed, Embase, and Cochrane library) of randomized controlled trials from conception to December 2020. The primary efficacy outcome was the occurrence of any stroke, the primary safety outcome was the bleeding risk, and the primary adverse outcome was the rate of headache and dizziness. The Mantel-Haenszel method was used to calculate a random-effects prediction. Cilostazol and aspirin were compared using a pooled risk assessment with 95% CIs. RESULTS: Six studies involving 5,617 patients were included in this review. Compared with aspirin monotherapy, cilostazol was associated with significantly lower rates of any strokes (RR: 0.67; 95% CI: 0.55-0.82) and significantly lower bleeding rates risk ratio (RR): 0.53; 95% CI: 0.37-0.74. However, compared with aspirin monotherapy, cilostazol was associated with significantly higher rates of headache (RR: 1.77; 95% CI: 1.41-2.20) and dizziness (RR: 1.28; 95% CI: 1.08-1.52). CONCLUSIONS: Consistent with previous studies, cilostazol monotherapy is superior to aspirin monotherapy in reducing the rate of any strokes and the bleeding risk after having a stroke. However, the use of cilostazol monotherapy is associated with several adverse life outcomes such as headaches and dizziness.
Chai et al. (Tue,) conducted a meta-analysis in Secondary stroke prevention (n=5,617). Cilostazol vs. Aspirin monotherapy (81-300 mg/day) was evaluated on Occurrence of any stroke (RR 0.67, 95% CI 0.55-0.82, p=<0.0001). Cilostazol monotherapy significantly reduced the risk of any stroke by 33% (RR 0.67) and lowered bleeding rates compared to aspirin, but increased the incidence of headache and dizziness.